|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP
|
Professional
|
Both
|
$4,168.00
|
|
|
Service Code
|
HCPCS 27823
|
| Min. Negotiated Rate |
$636.66 |
| Max. Negotiated Rate |
$3,182.48 |
| Rate for Payer: Aetna Commercial |
$1,313.54
|
| Rate for Payer: Aetna Medicare |
$2,084.00
|
| Rate for Payer: BCBS Complete |
$668.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,182.48
|
| Rate for Payer: BCN Commercial |
$1,447.95
|
| Rate for Payer: Cash Price |
$3,334.40
|
| Rate for Payer: Cash Price |
$3,334.40
|
| Rate for Payer: Meridian Medicaid |
$668.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$636.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,709.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,516.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,516.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,104.80
|
| Rate for Payer: UHC Exchange |
$1,104.80
|
| Rate for Payer: UHCCP Medicaid |
$636.66
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$3,537.00
|
|
|
Service Code
|
HCPCS 27822
|
| Min. Negotiated Rate |
$565.30 |
| Max. Negotiated Rate |
$3,847.61 |
| Rate for Payer: Aetna Commercial |
$1,164.75
|
| Rate for Payer: Aetna Medicare |
$1,768.50
|
| Rate for Payer: BCBS Complete |
$593.56
|
| Rate for Payer: BCBS Trust/PPO |
$3,847.61
|
| Rate for Payer: BCN Commercial |
$1,287.17
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Cash Price |
$2,829.60
|
| Rate for Payer: Meridian Medicaid |
$593.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$565.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,299.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,347.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,347.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$969.35
|
| Rate for Payer: UHC Exchange |
$969.35
|
| Rate for Payer: UHCCP Medicaid |
$565.30
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 92014
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$1,611.32 |
| Rate for Payer: Aetna Commercial |
$82.96
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,611.32
|
| Rate for Payer: BCN Commercial |
$134.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.60
|
| Rate for Payer: Priority Health Narrow Network |
$92.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.91
|
| Rate for Payer: UHC Exchange |
$82.91
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
|
|
PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 92004
|
| Min. Negotiated Rate |
$58.79 |
| Max. Negotiated Rate |
$1,175.47 |
| Rate for Payer: Aetna Commercial |
$103.20
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: BCBS Complete |
$61.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.47
|
| Rate for Payer: BCN Commercial |
$159.06
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Meridian Medicaid |
$61.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.02
|
| Rate for Payer: Priority Health Narrow Network |
$115.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.48
|
| Rate for Payer: UHC Exchange |
$105.48
|
| Rate for Payer: UHCCP Medicaid |
$58.79
|
|
|
PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 92012
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$1,213.51 |
| Rate for Payer: Aetna Commercial |
$55.00
|
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$33.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.51
|
| Rate for Payer: BCN Commercial |
$95.65
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Meridian Medicaid |
$33.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.46
|
| Rate for Payer: Priority Health Narrow Network |
$61.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.34
|
| Rate for Payer: UHC Exchange |
$54.34
|
| Rate for Payer: UHCCP Medicaid |
$31.52
|
|
|
PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE NEW PT
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 92002
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$902.86 |
| Rate for Payer: Aetna Commercial |
$50.66
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS Trust/PPO |
$902.86
|
| Rate for Payer: BCN Commercial |
$90.99
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.65
|
| Rate for Payer: Priority Health Narrow Network |
$55.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.77
|
| Rate for Payer: UHC Exchange |
$50.77
|
| Rate for Payer: UHCCP Medicaid |
$28.54
|
|
|
PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 34716
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$1,773.50 |
| Rate for Payer: Aetna Commercial |
$499.69
|
| Rate for Payer: Aetna Medicare |
$393.50
|
| Rate for Payer: BCBS Complete |
$244.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,773.50
|
| Rate for Payer: BCN Commercial |
$530.22
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Meridian Medicaid |
$244.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$578.10
|
| Rate for Payer: Priority Health Narrow Network |
$578.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.26
|
| Rate for Payer: UHC Exchange |
$503.26
|
| Rate for Payer: UHCCP Medicaid |
$232.60
|
|
|
PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 34834
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$1,323.92 |
| Rate for Payer: Aetna Commercial |
$174.94
|
| Rate for Payer: Aetna Medicare |
$145.00
|
| Rate for Payer: BCBS Complete |
$84.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,323.92
|
| Rate for Payer: BCN Commercial |
$184.23
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Meridian Medicaid |
$84.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.49
|
| Rate for Payer: Priority Health Narrow Network |
$200.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.69
|
| Rate for Payer: UHC Exchange |
$372.69
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
|
|
PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$1,267.00
|
|
|
Service Code
|
HCPCS 34812
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$823.55 |
| Rate for Payer: Aetna Commercial |
$278.36
|
| Rate for Payer: Aetna Medicare |
$633.50
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS Trust/PPO |
$498.72
|
| Rate for Payer: BCN Commercial |
$292.72
|
| Rate for Payer: Cash Price |
$1,013.60
|
| Rate for Payer: Cash Price |
$1,013.60
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.63
|
| Rate for Payer: Priority Health Narrow Network |
$319.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$455.35
|
| Rate for Payer: UHC Exchange |
$455.35
|
| Rate for Payer: UHCCP Medicaid |
$128.01
|
|
|
PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH
|
Professional
|
Both
|
$568.00
|
|
|
Service Code
|
HCPCS 34714
|
| Min. Negotiated Rate |
$168.06 |
| Max. Negotiated Rate |
$1,553.20 |
| Rate for Payer: Aetna Commercial |
$363.18
|
| Rate for Payer: Aetna Medicare |
$284.00
|
| Rate for Payer: BCBS Complete |
$176.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.20
|
| Rate for Payer: BCN Commercial |
$383.62
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Cash Price |
$454.40
|
| Rate for Payer: Meridian Medicaid |
$176.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$418.54
|
| Rate for Payer: Priority Health Narrow Network |
$418.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.00
|
| Rate for Payer: UHC Exchange |
$363.00
|
| Rate for Payer: UHCCP Medicaid |
$168.06
|
|
|
PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP
|
Professional
|
Both
|
$2,232.00
|
|
|
Service Code
|
HCPCS 34833
|
| Min. Negotiated Rate |
$244.52 |
| Max. Negotiated Rate |
$1,450.80 |
| Rate for Payer: Aetna Commercial |
$530.13
|
| Rate for Payer: Aetna Medicare |
$1,116.00
|
| Rate for Payer: BCBS Complete |
$256.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,407.92
|
| Rate for Payer: BCN Commercial |
$557.58
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Meridian Medicaid |
$256.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,450.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.46
|
| Rate for Payer: Priority Health Narrow Network |
$609.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$824.33
|
| Rate for Payer: UHC Exchange |
$824.33
|
| Rate for Payer: UHCCP Medicaid |
$244.52
|
|
|
PR OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH
|
Professional
|
Both
|
$4,812.00
|
|
|
Service Code
|
HCPCS 34830
|
| Min. Negotiated Rate |
$841.05 |
| Max. Negotiated Rate |
$3,127.80 |
| Rate for Payer: Aetna Commercial |
$2,372.61
|
| Rate for Payer: Aetna Medicare |
$2,406.00
|
| Rate for Payer: BCBS Complete |
$1,156.27
|
| Rate for Payer: BCBS Trust/PPO |
$841.05
|
| Rate for Payer: BCN Commercial |
$2,510.83
|
| Rate for Payer: Cash Price |
$3,849.60
|
| Rate for Payer: Cash Price |
$3,849.60
|
| Rate for Payer: Meridian Medicaid |
$1,156.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,101.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,127.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,744.22
|
| Rate for Payer: Priority Health Narrow Network |
$2,744.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,457.48
|
| Rate for Payer: UHC Exchange |
$2,457.48
|
| Rate for Payer: UHCCP Medicaid |
$1,101.21
|
|
|
PR OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH
|
Professional
|
Both
|
$4,077.00
|
|
|
Service Code
|
HCPCS 34831
|
| Min. Negotiated Rate |
$953.05 |
| Max. Negotiated Rate |
$3,001.08 |
| Rate for Payer: Aetna Commercial |
$2,587.95
|
| Rate for Payer: Aetna Medicare |
$2,038.50
|
| Rate for Payer: BCBS Complete |
$1,268.77
|
| Rate for Payer: BCBS Trust/PPO |
$953.05
|
| Rate for Payer: BCN Commercial |
$2,745.39
|
| Rate for Payer: Cash Price |
$3,261.60
|
| Rate for Payer: Cash Price |
$3,261.60
|
| Rate for Payer: Meridian Medicaid |
$1,268.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,208.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,650.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,001.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,001.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,616.66
|
| Rate for Payer: UHC Exchange |
$2,616.66
|
| Rate for Payer: UHCCP Medicaid |
$1,208.35
|
|
|
PR OPN SUBCLA CRTD ART TRPOS NCK INC ULAT
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 33889
|
| Min. Negotiated Rate |
$497.14 |
| Max. Negotiated Rate |
$2,852.29 |
| Rate for Payer: Aetna Commercial |
$1,063.36
|
| Rate for Payer: Aetna Medicare |
$1,600.00
|
| Rate for Payer: BCBS Complete |
$522.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,852.29
|
| Rate for Payer: BCN Commercial |
$1,130.80
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Meridian Medicaid |
$522.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$497.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,080.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,234.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,234.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,073.40
|
| Rate for Payer: UHC Exchange |
$1,073.40
|
| Rate for Payer: UHCCP Medicaid |
$497.14
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
IP
|
$77.11
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna Commercial |
$69.40
|
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Aetna Commercial |
$77.66
|
| Rate for Payer: ASR ASR |
$63.75
|
| Rate for Payer: ASR ASR |
$74.80
|
| Rate for Payer: ASR ASR |
$83.70
|
| Rate for Payer: ASR Commercial |
$74.80
|
| Rate for Payer: ASR Commercial |
$63.75
|
| Rate for Payer: ASR Commercial |
$83.70
|
| Rate for Payer: BCBS Trust/PPO |
$70.32
|
| Rate for Payer: BCBS Trust/PPO |
$53.56
|
| Rate for Payer: BCBS Trust/PPO |
$62.84
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: BCN Commercial |
$66.90
|
| Rate for Payer: BCN Commercial |
$59.78
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cofinity Commercial |
$81.11
|
| Rate for Payer: Cofinity Commercial |
$61.78
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$86.29
|
| Rate for Payer: Healthscope Whirlpool |
$74.80
|
| Rate for Payer: Healthscope Whirlpool |
$63.75
|
| Rate for Payer: Healthscope Whirlpool |
$83.70
|
| Rate for Payer: Mclaren Commercial |
$69.40
|
| Rate for Payer: Mclaren Commercial |
$59.15
|
| Rate for Payer: Mclaren Commercial |
$77.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.86
|
| Rate for Payer: Nomi Health Commercial |
$63.23
|
| Rate for Payer: Nomi Health Commercial |
$53.89
|
| Rate for Payer: Nomi Health Commercial |
$70.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
OP
|
$65.72
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$65.72 |
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Aetna Commercial |
$77.66
|
| Rate for Payer: Aetna Commercial |
$69.40
|
| Rate for Payer: Aetna Medicare |
$43.14
|
| Rate for Payer: Aetna Medicare |
$32.86
|
| Rate for Payer: Aetna Medicare |
$38.56
|
| Rate for Payer: ASR ASR |
$74.80
|
| Rate for Payer: ASR ASR |
$63.75
|
| Rate for Payer: ASR ASR |
$83.70
|
| Rate for Payer: ASR Commercial |
$74.80
|
| Rate for Payer: ASR Commercial |
$63.75
|
| Rate for Payer: ASR Commercial |
$83.70
|
| Rate for Payer: BCBS Complete |
$26.29
|
| Rate for Payer: BCBS Complete |
$30.84
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: BCBS Trust/PPO |
$70.66
|
| Rate for Payer: BCBS Trust/PPO |
$53.82
|
| Rate for Payer: BCBS Trust/PPO |
$63.15
|
| Rate for Payer: BCN Commercial |
$59.78
|
| Rate for Payer: BCN Commercial |
$66.90
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cofinity Commercial |
$81.11
|
| Rate for Payer: Cofinity Commercial |
$61.78
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.69
|
| Rate for Payer: Healthscope Commercial |
$86.29
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Whirlpool |
$83.70
|
| Rate for Payer: Healthscope Whirlpool |
$74.80
|
| Rate for Payer: Healthscope Whirlpool |
$63.75
|
| Rate for Payer: Mclaren Commercial |
$69.40
|
| Rate for Payer: Mclaren Commercial |
$77.66
|
| Rate for Payer: Mclaren Commercial |
$59.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.86
|
| Rate for Payer: Nomi Health Commercial |
$53.89
|
| Rate for Payer: Nomi Health Commercial |
$70.76
|
| Rate for Payer: Nomi Health Commercial |
$63.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.94
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
OP
|
$54.54
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$49.09
|
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna Commercial |
$41.92
|
| Rate for Payer: Aetna Commercial |
$69.40
|
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: Aetna Commercial |
$77.66
|
| Rate for Payer: Aetna Commercial |
$67.47
|
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Aetna Commercial |
$61.67
|
| Rate for Payer: Aetna Medicare |
$23.29
|
| Rate for Payer: Aetna Medicare |
$27.27
|
| Rate for Payer: Aetna Medicare |
$36.26
|
| Rate for Payer: Aetna Medicare |
$34.26
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna Medicare |
$38.56
|
| Rate for Payer: Aetna Medicare |
$43.14
|
| Rate for Payer: Aetna Medicare |
$32.86
|
| Rate for Payer: Aetna Medicare |
$59.67
|
| Rate for Payer: ASR ASR |
$66.46
|
| Rate for Payer: ASR ASR |
$63.75
|
| Rate for Payer: ASR ASR |
$45.18
|
| Rate for Payer: ASR ASR |
$52.90
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: ASR ASR |
$83.70
|
| Rate for Payer: ASR ASR |
$74.80
|
| Rate for Payer: ASR ASR |
$72.72
|
| Rate for Payer: ASR ASR |
$70.34
|
| Rate for Payer: ASR Commercial |
$83.70
|
| Rate for Payer: ASR Commercial |
$66.46
|
| Rate for Payer: ASR Commercial |
$63.75
|
| Rate for Payer: ASR Commercial |
$45.18
|
| Rate for Payer: ASR Commercial |
$74.80
|
| Rate for Payer: ASR Commercial |
$72.72
|
| Rate for Payer: ASR Commercial |
$52.90
|
| Rate for Payer: ASR Commercial |
$115.76
|
| Rate for Payer: ASR Commercial |
$70.34
|
| Rate for Payer: BCBS Complete |
$47.74
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: BCBS Complete |
$27.41
|
| Rate for Payer: BCBS Complete |
$29.01
|
| Rate for Payer: BCBS Complete |
$26.29
|
| Rate for Payer: BCBS Complete |
$18.63
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: BCBS Complete |
$30.84
|
| Rate for Payer: BCBS Complete |
$21.82
|
| Rate for Payer: BCBS Trust/PPO |
$44.66
|
| Rate for Payer: BCBS Trust/PPO |
$38.14
|
| Rate for Payer: BCBS Trust/PPO |
$70.66
|
| Rate for Payer: BCBS Trust/PPO |
$63.15
|
| Rate for Payer: BCBS Trust/PPO |
$56.11
|
| Rate for Payer: BCBS Trust/PPO |
$61.39
|
| Rate for Payer: BCBS Trust/PPO |
$59.39
|
| Rate for Payer: BCBS Trust/PPO |
$53.82
|
| Rate for Payer: BCBS Trust/PPO |
$97.73
|
| Rate for Payer: BCN Commercial |
$58.12
|
| Rate for Payer: BCN Commercial |
$59.78
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: BCN Commercial |
$53.12
|
| Rate for Payer: BCN Commercial |
$66.90
|
| Rate for Payer: BCN Commercial |
$42.28
|
| Rate for Payer: BCN Commercial |
$56.22
|
| Rate for Payer: BCN Commercial |
$36.11
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$37.27
|
| Rate for Payer: Cash Price |
$37.27
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cash Price |
$59.97
|
| Rate for Payer: Cash Price |
$59.97
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Cofinity Commercial |
$43.79
|
| Rate for Payer: Cofinity Commercial |
$64.41
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Cofinity Commercial |
$81.11
|
| Rate for Payer: Cofinity Commercial |
$51.27
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Cofinity Commercial |
$61.78
|
| Rate for Payer: Cofinity Commercial |
$68.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Commercial |
$54.54
|
| Rate for Payer: Healthscope Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$86.29
|
| Rate for Payer: Healthscope Commercial |
$68.52
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Healthscope Whirlpool |
$52.90
|
| Rate for Payer: Healthscope Whirlpool |
$83.70
|
| Rate for Payer: Healthscope Whirlpool |
$70.34
|
| Rate for Payer: Healthscope Whirlpool |
$74.80
|
| Rate for Payer: Healthscope Whirlpool |
$63.75
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Healthscope Whirlpool |
$66.46
|
| Rate for Payer: Healthscope Whirlpool |
$72.72
|
| Rate for Payer: Healthscope Whirlpool |
$45.18
|
| Rate for Payer: Mclaren Commercial |
$49.09
|
| Rate for Payer: Mclaren Commercial |
$61.67
|
| Rate for Payer: Mclaren Commercial |
$65.27
|
| Rate for Payer: Mclaren Commercial |
$69.40
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Mclaren Commercial |
$77.66
|
| Rate for Payer: Mclaren Commercial |
$67.47
|
| Rate for Payer: Mclaren Commercial |
$59.15
|
| Rate for Payer: Mclaren Commercial |
$41.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.54
|
| Rate for Payer: Nomi Health Commercial |
$44.72
|
| Rate for Payer: Nomi Health Commercial |
$97.86
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Nomi Health Commercial |
$56.19
|
| Rate for Payer: Nomi Health Commercial |
$70.76
|
| Rate for Payer: Nomi Health Commercial |
$38.20
|
| Rate for Payer: Nomi Health Commercial |
$59.47
|
| Rate for Payer: Nomi Health Commercial |
$53.89
|
| Rate for Payer: Nomi Health Commercial |
$63.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.94
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
IP
|
$119.34
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.57 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: Aetna Commercial |
$69.40
|
| Rate for Payer: Aetna Commercial |
$67.47
|
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna Commercial |
$61.67
|
| Rate for Payer: Aetna Commercial |
$49.09
|
| Rate for Payer: Aetna Commercial |
$77.66
|
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Aetna Commercial |
$41.92
|
| Rate for Payer: ASR ASR |
$83.70
|
| Rate for Payer: ASR ASR |
$66.46
|
| Rate for Payer: ASR ASR |
$63.75
|
| Rate for Payer: ASR ASR |
$45.18
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: ASR ASR |
$70.34
|
| Rate for Payer: ASR ASR |
$52.90
|
| Rate for Payer: ASR ASR |
$72.72
|
| Rate for Payer: ASR ASR |
$74.80
|
| Rate for Payer: ASR Commercial |
$83.70
|
| Rate for Payer: ASR Commercial |
$70.34
|
| Rate for Payer: ASR Commercial |
$66.46
|
| Rate for Payer: ASR Commercial |
$74.80
|
| Rate for Payer: ASR Commercial |
$72.72
|
| Rate for Payer: ASR Commercial |
$115.76
|
| Rate for Payer: ASR Commercial |
$45.18
|
| Rate for Payer: ASR Commercial |
$63.75
|
| Rate for Payer: ASR Commercial |
$52.90
|
| Rate for Payer: BCBS Trust/PPO |
$53.56
|
| Rate for Payer: BCBS Trust/PPO |
$59.10
|
| Rate for Payer: BCBS Trust/PPO |
$55.84
|
| Rate for Payer: BCBS Trust/PPO |
$97.25
|
| Rate for Payer: BCBS Trust/PPO |
$37.96
|
| Rate for Payer: BCBS Trust/PPO |
$44.44
|
| Rate for Payer: BCBS Trust/PPO |
$70.32
|
| Rate for Payer: BCBS Trust/PPO |
$62.84
|
| Rate for Payer: BCBS Trust/PPO |
$61.09
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: BCN Commercial |
$53.12
|
| Rate for Payer: BCN Commercial |
$66.90
|
| Rate for Payer: BCN Commercial |
$56.22
|
| Rate for Payer: BCN Commercial |
$59.78
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: BCN Commercial |
$42.28
|
| Rate for Payer: BCN Commercial |
$58.12
|
| Rate for Payer: BCN Commercial |
$36.11
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cash Price |
$59.97
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cash Price |
$37.27
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cofinity Commercial |
$68.17
|
| Rate for Payer: Cofinity Commercial |
$61.78
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Cofinity Commercial |
$64.41
|
| Rate for Payer: Cofinity Commercial |
$43.79
|
| Rate for Payer: Cofinity Commercial |
$81.11
|
| Rate for Payer: Cofinity Commercial |
$51.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.63
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Healthscope Commercial |
$54.54
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Commercial |
$68.52
|
| Rate for Payer: Healthscope Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$86.29
|
| Rate for Payer: Healthscope Whirlpool |
$72.72
|
| Rate for Payer: Healthscope Whirlpool |
$83.70
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Healthscope Whirlpool |
$66.46
|
| Rate for Payer: Healthscope Whirlpool |
$63.75
|
| Rate for Payer: Healthscope Whirlpool |
$45.18
|
| Rate for Payer: Healthscope Whirlpool |
$74.80
|
| Rate for Payer: Healthscope Whirlpool |
$70.34
|
| Rate for Payer: Healthscope Whirlpool |
$52.90
|
| Rate for Payer: Mclaren Commercial |
$61.67
|
| Rate for Payer: Mclaren Commercial |
$69.40
|
| Rate for Payer: Mclaren Commercial |
$77.66
|
| Rate for Payer: Mclaren Commercial |
$41.92
|
| Rate for Payer: Mclaren Commercial |
$49.09
|
| Rate for Payer: Mclaren Commercial |
$67.47
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Mclaren Commercial |
$59.15
|
| Rate for Payer: Mclaren Commercial |
$65.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.36
|
| Rate for Payer: Nomi Health Commercial |
$56.19
|
| Rate for Payer: Nomi Health Commercial |
$59.47
|
| Rate for Payer: Nomi Health Commercial |
$70.76
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Nomi Health Commercial |
$97.86
|
| Rate for Payer: Nomi Health Commercial |
$53.89
|
| Rate for Payer: Nomi Health Commercial |
$44.72
|
| Rate for Payer: Nomi Health Commercial |
$38.20
|
| Rate for Payer: Nomi Health Commercial |
$63.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.30
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$65.72
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$65.72 |
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: ASR ASR |
$63.75
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: ASR Commercial |
$115.76
|
| Rate for Payer: ASR Commercial |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$97.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.56
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Cofinity Commercial |
$61.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.58
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.75
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Mclaren Commercial |
$59.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.86
|
| Rate for Payer: Nomi Health Commercial |
$97.86
|
| Rate for Payer: Nomi Health Commercial |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$65.72
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$65.72 |
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: Aetna Medicare |
$59.67
|
| Rate for Payer: Aetna Medicare |
$32.86
|
| Rate for Payer: ASR ASR |
$63.75
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: ASR Commercial |
$115.76
|
| Rate for Payer: ASR Commercial |
$63.75
|
| Rate for Payer: BCBS Complete |
$26.29
|
| Rate for Payer: BCBS Complete |
$47.74
|
| Rate for Payer: BCBS Trust/PPO |
$53.82
|
| Rate for Payer: BCBS Trust/PPO |
$97.73
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Cofinity Commercial |
$61.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Whirlpool |
$63.75
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Mclaren Commercial |
$59.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: Nomi Health Commercial |
$53.89
|
| Rate for Payer: Nomi Health Commercial |
$97.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
|
|
PROPOFOL INFUSION (SYRINGE PUMP 20ML VIAL)(SHH)
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.67
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
PROPOFOL INFUSION (SYRINGE PUMP 20ML VIAL)(SHH)
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare |
$38.46
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Complete |
$30.76
|
| Rate for Payer: BCBS Trust/PPO |
$62.98
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,594.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$2,336.10 |
| Rate for Payer: Aetna Commercial |
$1,203.70
|
| Rate for Payer: Aetna Medicare |
$1,797.00
|
| Rate for Payer: BCBS Complete |
$614.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.26
|
| Rate for Payer: BCN Commercial |
$1,346.31
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Meridian Medicaid |
$614.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,336.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,401.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,401.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$955.12
|
| Rate for Payer: UHC Exchange |
$955.12
|
| Rate for Payer: UHCCP Medicaid |
$584.90
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$542.09 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna Commercial |
$1,112.25
|
| Rate for Payer: Aetna Medicare |
$1,190.00
|
| Rate for Payer: BCBS Complete |
$569.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.11
|
| Rate for Payer: BCN Commercial |
$1,246.61
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Meridian Medicaid |
$569.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,297.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,297.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$876.25
|
| Rate for Payer: UHC Exchange |
$876.25
|
| Rate for Payer: UHCCP Medicaid |
$542.09
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$599.17 |
| Max. Negotiated Rate |
$1,433.97 |
| Rate for Payer: Aetna Commercial |
$1,229.30
|
| Rate for Payer: Aetna Medicare |
$770.50
|
| Rate for Payer: BCBS Complete |
$629.13
|
| Rate for Payer: BCBS Trust/PPO |
$977.36
|
| Rate for Payer: BCN Commercial |
$1,377.09
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Meridian Medicaid |
$629.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,433.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$979.75
|
| Rate for Payer: UHC Exchange |
$979.75
|
| Rate for Payer: UHCCP Medicaid |
$599.17
|
|
